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兵頭 俊紀医学部附属病院 病理診断科助教
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■ 論文- Neural epidermal growth factor-like 1 protein (NELL1) is the second most common target antigen in membranous glomerulonephritis (MGN). However, data regarding the clinicopathological characteristics of NELL1-associated MGN are limited owing to its low prevalence. This study examined the prevalence and clinicopathological characteristics of NELL1-associated MGN in a Japanese cohort. Additionally, we compared the clinicopathological features of NELL1-positive MGN, phospholipase A2 receptor 1 (PLA2R1)-positive MGN, and MGN negative for all three antigens (NELL1, PLA2R1, and thrombospondin type-1 domain-containing 7A). Among 257 consecutive patients pathologically diagnosed with MGN at two centers in Japan, 24 (9.3%) were immunohistochemically positive for NELL1. Clinically, patients with NELL1-positive MGN were significantly older (p < 0.001) and had a higher frequency of bucillamine use (vs PLA2R1-positive MGN, p < 0.01). Histologically, NELL1-positive MGN exhibited significantly lower detection of spikes and crater formation (p < 0.001), higher prevalence of segmental spike distribution (vs PLA2R1-positive MGN: p < 0.001), and higher prevalence of stage I cases on electron microscopy (p < 0.01). There were no significant differences in the prognoses among the three groups. The characteristic histological feature of segmental distribution in NELL1-positive MGN may be related to bucillamine use and the early phase of the disease. Further investigations with larger numbers of patients may offer further insight into the prognosis of patients with NELL1-positive MGN.2024年09月, Virchows Archiv : an international journal of pathology, 英語, 国際誌研究論文(学術雑誌)
- PURPOSE: Tubulointerstitial nephritis (TIN) has various etiologies, including IgG4-related disease (IgG4-RD), autoimmune diseases, antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), and others. IgG4-positive plasma cell infiltration can occasionally be found in TIN unrelated to IgG4-RD. Therefore, there may be problems with usage of IgG4 immunostaining to differentiate between TIN with and TIN without IgG4-RD. This study aimed to compare the proportion of plasma cells that are positive for each IgG subclass and to clarify the predominant IgG subclass trends and clinical characteristics associated with IgG4-RD and non-IgG4-related interstitial nephritis. METHODS: The study enrolled 44 cases of TIN: 6 of IgG4-RD, 8 of autoimmune disease, 9 of AAV, and 21 of unknown disease group. In addition to clinical characteristics, IgG subclass composition of interstitial plasma cells was evaluated among 4 groups by immunohistochemistry. RESULTS: IgG1 was the predominant IgG subclass in TIN unrelated to IgG4-RD. In the IgG4-RD group, the IgG subclass rate was high in both IgG1 and IgG4. The rate of average IgG4-positive cells was significantly lower in the autoimmune disease group and unknown disease group compared with the IgG4-RD group. CONCLUSION: The present study revealed IgG1-dominant immune profiles of TIN unrelated to IgG4-RD. Further investigation is required to elucidate the clinicopathological differences between IgG1-dominant and IgG4-dominant groups in IgG4-RD.2024年02月, International urology and nephrology, 英語, 国際誌研究論文(学術雑誌)
- Not all patients with ulcerative colitis (UC) respond initially to treatment with biologic agents, and predicting their efficacy prior to treatment is difficult. Vedolizumab, a humanized monoclonal antibody against alpha 4 beta 7 (α4β7) integrin, suppresses immune cell migration by blocking the interaction between α4β7 integrin and mucosal addressin cell adhesion molecule 1. Reports about histological features that predict vedolizumab efficacy are scarce. So, we examined the association between histological features and vedolizumab efficacy. This was a multicenter, retrospective study of patients with UC treated with vedolizumab. Biopsy specimens taken from the colonic mucosa prior to vedolizumab induction were used, and the areas positively stained for CD4, CD68, and CD45 were calculated. Clinical and histological features were compared between those with and without remission at week 22, and the factors associated with clinical outcomes were identified. We enrolled 42 patients. Patients with a high CD4+ infiltration showed a better response to vedolizumab [odds ratio (OR) = 1.44, P = 0.014]. The concomitant use of corticosteroids and high Mayo scores had a negative association with the vedolizumab response (OR = 0.11, P = 0.008 and OR = 0.50, P = 0.009, respectively). Histological evaluation for CD4+ cell infiltration may be helpful in selecting patients who can benefit from vedolizumab.2023年11月, Scientific reports, 13(1) (1), 20262 - 20262, 英語, 国際誌研究論文(学術雑誌)
- KEY CLINICAL MESSAGE: Renal cell carcinoma as a secondary malignant neoplasm is relatively rare; however, the possibility of secondary renal cell carcinoma following chemoradiotherapy for childhood nephroblastoma should be considered. ABSTRACT: The occurrence of secondary renal cell carcinoma (RCC) following chemoradiotherapy for nephroblastoma is relatively rare, especially in microphthalmia transcription factor family translocation renal cell carcinoma. A 13-year-old Japanese male was referred to our department for treatment of a right kidney mass. The patient had undergone open left nephrectomy and adjuvant chemotherapy for nephroblastoma, 12 years before. Diagnostic imaging revealed a tumor in the right kidney and a lesion suspected to be metastasis in the left eighth rib. Chromophobe RCC or translocation RCC was suspected from the imaging pattern. TNM classification was cT1aN0M1, and the clinical stage was IV. Partial nephrectomy by robot-assisted surgery for the right renal tumor and resection of the left eighth rib were performed. Pathologically, the renal tumor was diagnosed as translocation RCC, and the rib lesion demonstrated no evidence of malignancy. We are currently undergoing imaging follow-up and the patient has been recurrence-free for 15 months. In this study, we present a rare case of secondary translocation RCC after successful treatment of nephroblastoma.2023年11月, Clinical case reports, 11(11) (11), e8128, 英語, 国際誌
- (一社)日本腎臓学会, 2023年09月, 日本腎臓学会誌, 65(6-W) (6-W), 771 - 771, 日本語COVID-19感染を契機にネフローゼ症候群を発症し,膜性増殖性糸球体腎炎(MGPN)と診断された1例
- BACKGROUND Various neoplasms, including neuroendocrine neoplasms (NENs), can arise from the presacral space. Most presacral lesions are detected due to symptoms arising from tumor growth. However, diagnosing small, asymptomatic presacral tumors is challenging because of their unique location. CASE REPORT A 63-year-old woman with chronic hepatitis C underwent follow-up after achieving a sustained virological response. Abdominal ultrasonography revealed multiple new hyperechoic masses in the liver. Physical and laboratory examinations, including tumor marker analysis, yielded unremarkable results. Computed tomography (CT) and magnetic resonance imaging (MRI) indicated metastatic liver tumors but failed to identify the primary site of these lesions. The hepatic mass was biopsied, leading to a diagnosis of grade 2 neuroendocrine tumor. 111In-pentetreotide somatostatin receptor scintigraphy revealed significant radiotracer accumulation in multiple hepatic masses, several bones, and a small presacral space lesion. Pathological examination of the presacral lesion confirmed a grade 2 neuroendocrine tumor, similar to the hepatic mass. Review of a CT scan performed 4 years earlier indicated a small cyst-like lesion in the presacral space suspected of being a developmental cyst; however, the presence of cystic components was not confirmed pathologically. The patient was diagnosed with a primary presacral neuroendocrine tumor, which might have originated from a developmental cyst, with multiple liver metastases. Chemotherapy with everolimus was initiated, and the clinical course has been uneventful. CONCLUSIONS We report a rare neuroendocrine tumor arising from the presacral space with multiple liver metastases. The presacral space should be examined when a NEN with an unknown primary site is found.2023年07月, The American journal of case reports, 24, e939614, 英語, 国際誌研究論文(学術雑誌)
- A 79-year-old female was diagnosed with a right renal tumor with a level II tumor thrombus of the vena cava. presurgical therapy was initiated with a combination of avelumab and axitinib for 3 monthes. Then, she underwent nephrectomy and thrombectomy. Histologically, the primary tumor and tumor thrombus had no viable cells, indicating that pathological complete response was achieved with presurgical tyrosine kinase inhibitor/Immuno-oncology combination therapy. An immunohistological xamination showed very strong staining for tumor-infiltrating lymphocytes in the embolized area of the tumor, with CD8 predominating over CD4.2021年11月, Urology case reports, 39, 101800 - 101800, 英語, 国際誌
- (株)文光堂, 2021年06月, 病理と臨床, 39(6) (6), 611 - 616, 日本語
- A 78-year-old man who underwent right nephrectomy for renal cell carcinoma (RCC) 18 years ago visited our hospital complaining of abdominal pain. Imaging revealed that the pancreatic head tumor obstructed the Santorini duct. We suspected a pancreatic intraductal tumor, such as an intraductal tubulopapillary neoplasm or intraductal papillary mucinous neoplasm. Thus, the patient underwent subtotal stomach-preserving pancreaticoduodenectomy. Pathological findings confirmed the diagnosis of metastatic RCC. Herein, we report a case of pancreatic metastasis of an RCC that presented with a tumor in the pancreatic duct.2021年06月, Clinical journal of gastroenterology, 14(3) (3), 905 - 909, 英語, 国内誌研究論文(学術雑誌)
- BACKGROUND Microscopic tumor foci have been detected incidentally on renal biopsy, including renal cell carcinoma and renomedullary interstitial cell tumor (medullary fibroma). A report is presented of a case of an incidental finding of microscopic renal angiomyolipoma that was diagnosed and completely excised on core needle biopsy. CASE REPORT A 44-year-old woman was referred to our hospital for evaluation of persistent mild proteinuria. Three years previously, she was diagnosed with Cushing's syndrome associated with a right adrenal cortical adenoma, which was successfully treated with unilateral adrenalectomy. At the time of surgery, abdominal computed tomography (CT) showed no renal lesions. During the present admission, a renal biopsy was performed that showed minimal changes in the renal glomeruli and interstitium. Immunofluorescence showed weakly positive staining for IgM in the glomeruli and no dense deposits. A microscopic focus of a predominantly spindle-cell tumor was found in the corticomedullary region. Immunohistochemistry showed positive immunostaining for HMB-45, Melan-A, and alpha-smooth muscle actin (ASMA), which supported a diagnosis of angiomyolipoma. Abdominal ultrasound at one-year follow-up showed no evidence of residual renal tumor. CONCLUSIONS To our knowledge, this is the first reported case of a completely excised incidental microscopic renal angiomyolipoma. This case demonstrated that even when imaging findings are normal, renal biopsy may detect microscopic foci of primary renal tumors.2020年03月, The American journal of case reports, 21, e921353, 英語, 国際誌
- Thrombospondin type 1 domain-containing 7A (THSD7A) is a recently identified target antigen of idiopathic membranous nephropathy (iMN). The clinicopathological characteristics of THSD7A-associated MN are poorly characterised due to low prevalence among MN patients. Among 469 consecutive cases of pathologically confirmed MN diagnosed at four centres in Japan, 14 cases were confirmed positive for THSD7A by immunohistochemistry (3.0%). The prevalence of THSD7A-associated MN tended to be higher in northern Japan. Most cases demonstrated nephrotic-range proteinuria (12/14 cases, 86%). In two patients, cancer was detected at the time of renal biopsy (small-cell carcinoma of the lung and prostatic adenocarcinoma with neuroendocrine differentiation). Both tumours were negative for THSD7A. Four patients had concurrent or previous incidence of allergic diseases, including one patient with Kimura's disease. Pathological analysis of kidney biopsy tissue revealed slight mesangial cell proliferation in three cases and spike formation in one case. Immunofluorescence studies demonstrated that IgG subclass was mainly IgG4-dominant/codominant (12/13, 92% cases), while the case with prostatic cancer had an IgG2-dominant distribution. The immunostaining profile for components of the lectin complement pathways was not significant in three cases including two patients with malignancy. One case was dual positive for THSD7A and PLA2R. Of 10 cases with known clinical follow-up data, 6 demonstrated reduced serum creatinine and 8 presented reduced proteinuria. In summary, although the major IgG phenotype was usually IgG4-dominant/codominant, clinical background was otherwise heterogeneous. Further investigation of regional differences in THSD7A-associated MN prevalence may reveal genetic and environmental risk factor and associated pathogenic mechanisms.2019年06月, Virchows Archiv : an international journal of pathology, 474(6) (6), 735 - 743, 英語, 国際誌研究論文(学術雑誌)
- A 77-year-old man was referred to our hospital with persistent proteinuria and progressive lower leg edema. Past history was unremarkable except for hypertension. Autoimmune diseases, infections, and malignancies were excluded based on clinical and laboratory test results. Renal biopsy specimens showed membranous nephropathy with segmental distribution of spikes and bubbling appearance. Double contour formation in glomerular tufts was also observed. There were no proliferative changes in the glomeruli. Interstitial fibrosis and tubular atrophy were moderate, and no interstitial inflammation was observed. Arteries showed moderate sclerotic changes with hyalinosis. Immunohistochemical analysis revealed no thrombospondin type 1 domain-containing 7A reactivity. Immunofluorescence staining showed segmental granular positivity of IgG on glomerular tufts and focal staining of IgG on the tubular basement membranes. IgG deposits (subclass distribution: IgG1, 2+; IgG2, -; IgG3, 1+; IgG4, 2+) and phospholipase A2 receptor type 1 (PLA2R1) immunoreactivity showed similar distributions in both glomeruli and renal tubular basement membranes. Electron microscopy revealed subendothelial edema in partially collapsed glomerulus. No subepithelial dense deposits were observed in the glomeruli under an electron microscope. This is the first documented case of membranous nephropathy (MN) with segmental distribution of PLA2R1 in the glomeruli and focal PLA2R1 positivity in renal tubular basement membranes. Our findings extend the pathological presentation of PLA2R1-associated MN. Future studies are required to examine the mechanistic insights of these atypical histopathological features. .2019年02月, Clinical nephrology, 91(2) (2), 114 - 119, 英語, 国際誌研究論文(学術雑誌)
- Renal cell carcinoma (RCC) occasionally has sarcomatoid differentiation and rarely contains heterologous components. We report a case of chromophobe RCC with sarcomatoid differentiation that had various heterologous components including a unique lipomatous area. The patient was an 83-year-old woman with a palpable mass in the left lower abdomen. Grossly, the tumor was 14 cm in diameter and had yellowish-to-whitish color with focal necrosis and hemorrhage. Histologically, the tumor was composed of an eosinophilic subtype of chromophobe RCC with sarcomatoid differentiation including mainly chondrosarcoma, some osteosarcoma and a lipomatous area. The heterologous components of sarcomatoid RCC are usually osteosarcoma or chondrosarcoma, and sarcomatoid RCC with multiple heterologous components is extremely rare.2018年09月, Pathology international, 68(9) (9), 524 - 529, 英語, 国際誌研究論文(学術雑誌)
- Standard therapy for radioactive iodine (RAI)-refractory differentiated thyroid cancer (DTC) is multi-targeted kinase inhibitors (m-TKIs), represented by sorafenib and lenvatinib. One of the main target molecules of m-TKIs is vascular endothelial growth factor receptor (VEGF-R). m-TKIs are known to cause adverse reactions such as hypertension and proteinuria as a class effect. In particular, proteinuria is thought to result from vascular endothelial damage and podocytopathy in glomeruli, and the development of thrombotic microangiopathy (TMA) has been reported for VEGF inhibitors. We encountered a patient with RAI-refractory (RR) papillary thyroid carcinoma (PTC) who developed proteinuria and renal dysfunction due to lenvatinib. Renal biopsy demonstrated that these changes were caused by TMA. To our knowledge, this is the first reported case of TMA due to lenvatinib in a Japanese patient with RR-PTC. A 70-year-old woman developed proteinuria, renal impairment and hypertension while receiving lenvatinib for RR-PTC. Her proteinuria and renal damage continued to worsen despite dose reductions and dose interruptions. Renal biopsy was consistent with the chronic type of TMA. These findings indicate that TMA is a possible cause of proteinuria due to lenvatinib, as has been reported for the VEGF inhibitors. (C) 2018 The Author(s) Published by S. Karger AG, BaselKARGER, 2018年, CASE REPORTS IN ONCOLOGY, 11(3) (3), 735 - 741, 英語研究論文(学術雑誌)
- (一社)日本腎臓学会, 2023年09月, 日本腎臓学会誌, 65(6-W) (6-W), 771 - 771, 日本語COVID-19感染を契機にネフローゼ症候群を発症し,膜性増殖性糸球体腎炎(MGPN)と診断された1例
- (一社)日本腎臓学会, 2023年09月, 日本腎臓学会誌, 65(6-W) (6-W), 773 - 773, 日本語COVID-19契機に非典型的溶血性尿毒症症候群(aHUS)を発症し維持透析に至った若年者の一例
- (株)文光堂, 2023年04月, 病理と臨床, 41(臨増) (臨増), 133 - 133, 日本語
- (株)文光堂, 2023年04月, 病理と臨床, 41(臨増) (臨増), 134 - 134, 日本語
- (一社)日本病理学会, 2022年03月, 日本病理学会会誌, 111(1) (1), 213 - 214, 日本語Renal medullary angiitis4例の臨床病理学的検討
- (一社)日本病理学会, 2022年03月, 日本病理学会会誌, 111(1) (1), 338 - 338, 日本語微小変化型ネフローゼ症候にみられるIgG dustingの検討
- (一社)日本病理学会, 2022年03月, 日本病理学会会誌, 111(1) (1), 338 - 338, 日本語尿細管間質性腎炎55例の免疫組織化学染色を用いたIgG subclass検討
- 2022年, 日本形成外科学会会誌, 42(4) (4)母指指動脈の切断,吻合による再建が必要であった母指筋周皮腫の一例
- 2021年, 日本腎臓学会誌(Web), 63(6-W) (6-W)難治性重症ネフローゼ症候群に対し免疫抑制療法と血漿交換により完全寛解に至ったSLEの一例
- 2021年, 日本腎臓学会誌(Web), 63(6-W) (6-W)Medullary angiitisと診断した腎膿瘍疑い症例
- 2021年, 病理と臨床, 39(4) (4)マクロクイズ 第144回
- (一社)日本内分泌学会, 2020年10月, 日本内分泌学会雑誌, 96(2) (2), 513 - 513, 日本語PTU服用開始9年後にANCA関連血管炎を発症した一例
- (一社)日本病理学会, 2020年03月, 日本病理学会会誌, 109(1) (1), 437 - 437, 日本語Oligomeganephronia9例の臨床病理学的検討
- 肝細胞癌治療経過中に肝原発の神経内分泌癌を併発した症例症例は68歳女性。XX-18年にC型肝硬変を指摘され保存的に治療されていた。XX-3年に肝細胞癌(hepatocellular carcinoma;HCC)を認め、合計3回のtransarterial chemoembolism;TACE、さらに腫瘍再発・門脈侵襲に対して放射線治療を施行。しかし治療反応性は乏しく腫瘍は急激に転移・増大した。XX年2月食道静脈瘤破裂による失血で死亡。病理解剖にてHCCは壊死しており、残存する腫瘍はすべて神経内分泌癌(neuroendocrine carcinoma;NEC)であった。治療を繰り返すうちにHCCがNECに転化、併存するようになったと思われる。既報告例ではfirst treatmentでHCCとNECの共存例ばかりであるが、本症例のように治療の経過中にHCCにNECが合併する症例はない。貴重な症例と考え報告する。(著者抄録)(一社)日本肝臓学会, 2020年03月, 肝臓, 61(3) (3), 122 - 128, 日本語
- 2020年, 日本内分泌学会雑誌, 96(4 (Web)) (4 (Web))Basedow病治療中にANCA関連血管炎を発症し,血管炎の病理所見を得た高齢女性の一例
- 2020年, 日本腎臓学会誌(Web), 62(6) (6)感染後糸球体腎炎を契機に発症した高齢者微小変化型ネフローゼ症候群のステロイド治療完全寛解症例
- (一社)日本病理学会, 2019年04月, 日本病理学会会誌, 108(1) (1), 405 - 405, 日本語Fabry病遺伝子変異と腎病理像 E66Q変異はFabry病か否か?
- 2019年, 日本内分泌学会雑誌, 95(1) (1)痩せ型糖尿病と筋力低下から診断に至ったクッシング症候群の1例
- 2019年, 日本医学放射線学会秋季臨床大会抄録集, 55th腸間膜に発生した悪性末梢神経鞘腫の1例
- 2019年, 日本内分泌学会雑誌, 95(1) (1)急速に健忘,意欲低下が進行した鞍上部血管腫の1例
- 2019年, 日本腎臓学会誌, 61(3) (3)ゲフィチニブで治療中に急速進行性糸球体腎炎の経過を辿った肺がん患者の1例
- (一社)日本病理学会, 2018年04月, 日本病理学会会誌, 107(1) (1), 448 - 448, 日本語結晶様構造物を伴う近位尿細管障害像をきたした多発性骨髄腫の一例
- 2018年, 日本内分泌学会雑誌, 94(4 (Web)) (4 (Web))皮膚筋炎の診断から発見に至った甲状腺乳頭癌の1例
- 2018年, 日本乳癌学会学術総会プログラム・抄録集, 26th乳癌の卵巣転移と原発性卵巣癌の鑑別が困難であった1症例
- 2018年, 肝臓, 59(Supplement 3) (Supplement 3)肝細胞癌治療経過中に神経内分泌癌を合併したC型肝硬変の一剖検例